The management of tonic-clonic status epilepticus (TCSE)

Tonic-clonic status epilepticus (TCSE) can be defined as a condition in which prolonged or recurrent tonic-clonic seizures (TCS) persist for 30 min or more. The earlier the treatment is initiated the more easily it is resolved. It is most common in children, mentally handicapped, and those with structural cerebral pathology especially in the frontal lobes. In known epileptics, TCSE can be precipitated by drug withdrawal or non-compliance, inter-current illness, alcohol and drug toxicity, metabolic derangement, or progression of an underlying pathology. The principles of management include rapid cessation of the seizure to prevent primary neuronal injury diagnosis and treatment of the underlying condition, and prevention of relapse with appropriate anticonvulsant therapy.